Greenfield Skilled Nursing And Rehabilitation

F 0568 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some

FORM CMS-2567 (02/99) Previous Versions Obsolete

money out of the building. They also confirmed staff reported concerns of SS #210 asking activity aides to sign blank facility receipts for resident fund withdrawals and when questioned by staff, SS #210 reported

she would fill in an amount later once an amount was known. Interview on 08/18/25 at 3:25 P.M. with Activity Aide (AA) #70 confirmed Social Service (SS) #210 had asked her to have residents sign a blank receipt to take out resident funds. She questioned it and SS #210 stated she would fill in an amount later.

AA #70 reported she just had residents sign the ones with amounts, and put the receipt book back with the blank receipts left unsigned. Review of the facility policy titled, Deposit of Resident Funds, dated 04/2017 revealed resident personal funds shall be held and managed by the facility and shall be safeguarded.

Funds over $50 shall be deposited in an interest bearing account. Facility did not provide any evidence of written policy or procedure regarding staff shopping for residents and signing out resident money to staff.

This deficiency represents non-compliance investigated under Complaint Number 1342630 and 2580694.

Event ID:

Facility ID:

If continuation sheet

Printed: 04/13/2026 Form Approved OMB No. 0938-0391

Department of Health & Human Services Centers for Medicare & Medicaid Services STATEMENT OF DEFICIENCIES AND PLAN OF CORRECTION

(X1) PROVIDER/SUPPLIER/CLIA IDENTIFICATION NUMBER:

(X2) MULTIPLE CONSTRUCTION

B. Wing

A. Building

(X3) DATE SURVEY COMPLETED

08/20/2025

NAME OF PROVIDER OR SUPPLIER

STREET ADDRESS, CITY, STATE, ZIP CODE

Greenfield Skilled Nursing and Rehabilitation

238 South Washington Street Greenfield, OH 45123

For information on the nursing home's plan to correct this deficiency, please contact the nursing home or the state survey agency. (X4) ID PREFIX TAG

SUMMARY STATEMENT OF DEFICIENCIES (Each deficiency must be preceded by full regulatory or LSC identifying information)

F 0602 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few

FORM CMS-2567 (02/99) Previous Versions Obsolete

SS had taken resident fund money home with her. Interview on 08/18/25 at 3:00 with Administrator and Regional Account Manager #205 confirmed Social Services (SS) #210 took resident money to her home.

They confirmed staff regularly shop for residents and they did not have a standard procedure for staff taking resident money and how long they could keep the money before returning it, or returning the resident's change. They acknowledged SS #210's statement included a report she had $500.00 for Resident #42 for several months in her personal vehicle. They acknowledged the risk of theft with no checks and balances and no one making sure staff followed any guidelines when taking residents money out of the building.

Review of facility policy titled, Abuse Neglect, Exploitation and Misappropriation Prevention Program, dated 04/2021 revealed Residents had the right to be free from misappropriation. Facility shall protect residents from misappropriations by anyone including facility staff. Facility shall develop and implement policies and protocols to prevent and identify misappropriation. This deficiency represents non-compliance investigated under Complaint Number 1342630 and 2580694.

Event ID:

Facility ID:

If continuation sheet

Printed: 04/13/2026 Form Approved OMB No. 0938-0391

Department of Health & Human Services Centers for Medicare & Medicaid Services STATEMENT OF DEFICIENCIES AND PLAN OF CORRECTION

(X1) PROVIDER/SUPPLIER/CLIA IDENTIFICATION NUMBER:

(X2) MULTIPLE CONSTRUCTION

B. Wing

A. Building

(X3) DATE SURVEY COMPLETED

08/20/2025

NAME OF PROVIDER OR SUPPLIER

STREET ADDRESS, CITY, STATE, ZIP CODE

Greenfield Skilled Nursing and Rehabilitation

238 South Washington Street Greenfield, OH 45123

For information on the nursing home's plan to correct this deficiency, please contact the nursing home or the state survey agency. (X4) ID PREFIX TAG

SUMMARY STATEMENT OF DEFICIENCIES (Each deficiency must be preceded by full regulatory or LSC identifying information)

F 0610 Level of Harm - Minimal harm or potential for actual harm

persons involved in the alleged incident. Upon receiving allegations, the Administrator was responsible for determining what actions were needed for resident protection.This deficiency represents non-compliance investigated under Complaint Number 1342630 and Complaint Number 2580694.

Residents Affected - Some

FORM CMS-2567 (02/99) Previous Versions Obsolete

Event ID:

Facility ID:

If continuation sheet

Printed: 04/13/2026 Form Approved OMB No. 0938-0391

Department of Health & Human Services Centers for Medicare & Medicaid Services STATEMENT OF DEFICIENCIES AND PLAN OF CORRECTION

(X1) PROVIDER/SUPPLIER/CLIA IDENTIFICATION NUMBER:

(X2) MULTIPLE CONSTRUCTION

B. Wing

A. Building

(X3) DATE SURVEY COMPLETED

08/20/2025

NAME OF PROVIDER OR SUPPLIER

STREET ADDRESS, CITY, STATE, ZIP CODE

Greenfield Skilled Nursing and Rehabilitation

238 South Washington Street Greenfield, OH 45123

For information on the nursing home's plan to correct this deficiency, please contact the nursing home or the state survey agency. (X4) ID PREFIX TAG

SUMMARY STATEMENT OF DEFICIENCIES (Each deficiency must be preceded by full regulatory or LSC identifying information)

F 0627 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few

FORM CMS-2567 (02/99) Previous Versions Obsolete

signed discharge paperwork with Resident #48's son (Power of Attorney (POA)). Resident #48 discharged with her POA. The note dated 05/22/25 from Social Services #210 revealed Resident #48 was discharging home with her son and home health and appointments were set up.Review of Resident #48's discharge Minimum Data Set (MDS) assessment dated [DATE REDACTED] revealed a Brief Interview of Mental Status (BIMS) of 06 indicating impaired cognition. It stated Resident #48 required set up assistance for eating, substantial maximum assistance for oral hygiene, shower/bathing, upper body dressing, personal hygiene, rolling, sitting up in bed and sitting at the edge of the bed and she was dependent upon staff with toileting assistance, lower body dressing, placing footwear, mobility from sit to stand, chair to bed transfers, toilet transfers, and shower transfers. Car transfers and walking 10 feet were not attempted due to medical or safety concerns.Review of the discharge summary/discharge plan of care dated 05/22/25 revealed Resident #48 was discharged due to meeting therapy goals. It also stated Resident #48 was set up with home healthcare for aide services as well as physical and occupational therapy services and named Ross County Home Health as the provider.Interview on 08/14/25 at 1:15 P.M. with Therapy Director (TD) #60 revealed Resident #48 was cut from therapy and had requested to discharge home with her family at that time instead of paying privately. TD #60 revealed Resident #48's family was reluctant about taking her home and she felt the resident had pressured her family to take her home at discharge.Interview on 08/14/25 at 4:00 P.M. with Administrator revealed Resident #48's insurance informed the facility on 05/14/25 that her days were about to be exhausted and she had seven days left, with the last covered day being 05/21/25.

She confirmed the note mentioned the facility was to provide discharge planning.Interview on 08/18/25 at 11:56 A.M. with Home Health Agency: Ross County Home Health revealed they denied the referral for Resident #48 and stated they were out of network with her insurance. They stated they received the referral

on 05/22/25 and informed Social Services staff on 05/22/25 they were out of network. They revealed they did not hear back and followed up with a second email informing the facility they were out of network on 06/01/25, and again did not receive any response or confirmation back. They confirmed they had never met with Resident #48 or initiated services.Interview on 08/18/25 at 12:25 P.M. with Director of Nursing (DON) revealed she had an expectation of a safe discharge plan and the previous social services staff should have confirmed acceptance of a home health agency. The DON confirmed the discharge summary did not give

an accurate reason for discharge as it stated the resident met therapy goals. She also acknowledged the agency listed did not begin any services and confirmed the facility sent Resident #48 home without the needed and recommended services, which was not a safe discharge plan.Interview on 08/18/25 at 1:55 P.M. with Regional Nurse (RN) #200 confirmed the facility had no evidence of Resident #48 having an accepted home health agency at the time of discharge. RN #200 confirmed the facility only had evidence that two referrals were sent on 05/22/25 and none were sent prior to the day of discharge. RN #200 confirmed the facility had no evidence of prior discharge planning and no evidence a discharge care conference was held. RN #200 confirmed she received an email in June 2025 about referrals for Resident #48 and stated it was not our job to ensure the resident had services arranged prior to discharge to ensure

a safe discharge plan.Interview on 08/18/25 at 1:55 P.M. with Regional Nurse (RN) #200 and Regional Account Manager (RAM) #205 reported the facility had discussions with Resident #48 and her family regarding difficulties with the insurance and acknowledged the facility had no evidence of the discussions and no documentation of difficulties with discharge planning.This deficiency represents non-compliance investigated under Complaint Number 2581704.

Event ID:

Facility ID:

If continuation sheet